PLAAF score as a novel predictor of long-term outcome after second-generation cryoballoon pulmonary vein isolation

Akkaya, Ersan; Berkowitsch, Alexander; Greiß, Harald; Hamm, Christian W.; Sperzel, Johannes; Neumann, Thomas; Kuniss, Malte

doi:10.1093/europace/eux295

Cited by 20 publications

(29 citation statements)

References 28 publications

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“…In contrast to exclusively CBA studies by Oto et al, Canpolat et al, and Akkaya et al, our study did not show smoking status, AF duration, PeAF, or BMI to be significant predictors of RAF . We also did not find additional components of PLAAF score, such as female gender and variant pulmonary vein anatomy, to be predictors of RAF . Our study did not find additional components of the ALARMEc risk score (mixed CBA and radiofrequency ablation population) including renal insufficiency, metabolic syndrome, and presence of cardiomyopathy to be significant predictors of RAF…”

Section: Discussioncontrasting

confidence: 99%

“…The main findings of our study were that only LAD > 40 mm and ERAF were significant predictors of RAF and that BASEAF2 had the best performance of existing clinical risk scores in predicting RAF. Other studies have consistently shown a large LAD to be a predictor of recurrence following CBA . Similar to our data, other studies have also shown that recurrence of AF in blanking period is a predictor of later recurrence in both PAF and PeAF population .…”

Section: Discussionsupporting

confidence: 91%

“…Other studies have consistently shown a large LAD to be a predictor of recurrence following CBA. 7,15,16 Similar to our data, other studies have also shown that recurrence of AF in blanking period is a predictor of later recurrence in both PAF and PeAF population. [16][17][18] In contrast to exclusively CBA studies by Oto et al, Canpolat et al, and Akkaya et al, our study did not show smoking status, AF duration, PeAF, or BMI to be significant predictors of RAF.…”

Section: Discussionsupporting

confidence: 90%

“…Similar to our data, other studies have also shown that recurrence of AF in blanking period is a predictor of later recurrence in both PAF and PeAF population . In contrast to exclusively CBA studies by Oto et al, Canpolat et al, and Akkaya et al, our study did not show smoking status, AF duration, PeAF, or BMI to be significant predictors of RAF . We also did not find additional components of PLAAF score, such as female gender and variant pulmonary vein anatomy, to be predictors of RAF .…”

Section: Discussionsupporting

confidence: 86%

“…Looking at RAF through this strict dichotomous prism instead of considering AF burden may limit identification of consistent predictors and be of less clinical utility. Finally, our time point of recurrence at 3–12 months was different from the PLAAF study that evaluated recurrence at 36 months …”

Section: Discussionmentioning

confidence: 97%

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Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Bavishi

Kaplan

Peigh

et al. 2019

Pacing Clinical Electrophis

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Background While several studies have evaluated predictors for atrial fibrillation (AF) recurrence following catheter ablation, there are limited data specific to cryoballoon ablation (CBA). Methods We analyzed a prospective registry of patients at a single institution who underwent CBA. Recurrence of AF (RAF) was defined as recurrence of AF by 12‐month follow‐up, excluding the 3‐month blanking period. Univariate analysis was performed to evaluate predictors of RAF. Receiver operating characteristic analysis was used to compare and evaluate the performance of various risk scores for discriminating risk of RAF. Results There were 542 patients included in the analysis with mean age 61.3 ± 10.6 years, 67.9% male, and 51.6% paroxysmal AF (PAF). Overall, only left atrial diameter (LAD) > 40 mm and ERAF (early recurrence of AF within 0‐3 month blanking period) were significant predictors of RAF. In the PAF specific subgroup, LAD > 40 mm, AF duration > 12 months, prior stroke or transient ischemic attack, ERAF, and having previously failed an antiarrhythmic drug were significant predictors of RAF. In persistent AF (PeAF) subgroup, obstructive sleep apnea (OSA) and ERAF were significant predictors of RAF. Out of clinical risk scores tested, BASEAF2 had the highest performance with area under the curve of 0.646 (95% confidence interval [0.548, 0.708]; P < .01). Conclusions In this single‐center retrospective study of CBA, we found only LAD > 40 mm and ERAF to be predictors of RAF. We identified OSA as a potential targetable risk factor in PeAF patients undergoing CBA. Out of risk scores tested for discriminating risk of RAF, BASEAF2 had the best performance.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 97%

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Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Bavishi

Kaplan

Peigh

et al. 2019

Pacing Clinical Electrophis

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Variations in human pulmonary vein ostia morphology: A systematic review with meta‐analysis

et al. 2022

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This study aimed to establish the most accurate and up‐to‐date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta‐analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left‐sided PVs have smaller ostia than the corresponding right‐sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta‐analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.

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Comparison of six risk scores for the prediction of atrial fibrillation recurrence after cryoballoon‐based ablation and development of a simplified method, the 0‐1‐2 PL score

Jastrzębski

Kiełbasa

Fijorek

et al. 2021

Journal of Arrhythmia

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Introduction There are several prognostic scores for the assessment of risk of atrial fibrillation (AF) recurrence post ablation procedure. However, the use of these complex scores is difficult and the validation on different populations brought divergent results. Our goal was to compare the performance of these risk scores as the basis for the development of a new, simplified score based only on few universally predictive variables. Methods All cryoballoon‐based AF ablations performed in a single‐center over a 10‐year period were prospectively analyzed with regard to AF recurrence. This served to analyze the performance of APPLE, CAAP‐AF, SCALE‐CryoAF, MB‐LATER, CHADS2, and CHA2DS2‐VASc risk scores. Results A total of 597 patients, mostly (78.1%) with paroxysmal AF were studied. Analyzed risk scores performed poorer than in the original publications because some risk factors were not predictive of AF recurrence. A simplified score named 0‐1‐2 PL, composed of just two universally predictive variables, AF type (1 point for Persistent AF) and LA dimension (1 point for LA size >45 mm) was developed. The 0‐1‐2 PL score stratified patients into low risk (0 points), intermediate risk (1 point), and high risk categories (2 points) which were related to a 2‐year risk of AF recurrence of 21%, 37%, and 55%, respectively. This score had C‐statistics (0.620) higher/comparable to other investigated much more complex scores. Conclusion The assessment of risk of AF recurrence at the pre‐ablation stage can be simplified without compromising accuracy. This could help to popularize risk assessment and standardization of AF management.

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PLAAF score as a novel predictor of long-term outcome after second-generation cryoballoon pulmonary vein isolation

Abstract: PVI using the cryoballoon technique shows acceptable long-term results depending on predictors described by the new PLAAF score, which may facilitate patient selection for PVI.

Cited by 20 publications

References 28 publications

Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Variations in human pulmonary vein ostia morphology: A systematic review with meta‐analysis

Comparison of six risk scores for the prediction of atrial fibrillation recurrence after cryoballoon‐based ablation and development of a simplified method, the 0‐1‐2 PL score

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